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Neuropathic Pain in MS: Can Duloxetine Help?

the MPR take:

While neuropathic pain is common in patients with multiple sclerosis (MS), pharmacological treatment can be challenging due to underlying pathophysiologic mechanisms. A new study in Pain Practice explores the efficacy and tolerability of duloxetine, a serotonin and norepinephrine reuptake inhibitor, as a treatment for neuropathic pain in patients with multiple sclerosis (NP-MS). Two hundred thirty-nine adults with NP-MS were randomized to receive duloxetine 60mg (30mg/day for one week, followed by 60mg/day for five weeks) or placebo over a six-week acute therapy phase and a 12-week open-table extension phase (duloxetine 30–120mg/day). Participants rated average pain intensity (API) daily on an 11-point numeric scale in an electronic diary. The mean change in weekly API ratings from baseline to week six was greater for patients taking duloxetine vs. those taking placebo (-1.83 vs. -1.07, respectively), with the difference statistically significant as early as week one of treatment and remaining significant for each subsequent week. At the end of the 12-week open-label extension phase, API improvements were reported in patients from the previous duloxetine and placebo arms, with greater improvement reported by patients who had previously received placebo. While duloxetine is currently not indicated for the treatment of neuropathic pain in MS patients, the results of this study support its efficacy as a therapy to improve pain symptoms in this patient population.

Background: Patients with multiple sclerosis (MS) often report neuropathic pain (NP-MS). The purpose of this study was to assess the efficacy and tolerability of duloxetine as treatment for NP-MS. Methods: In this study, 239 adults with NP-MS (duloxetine = 118, placebo = 121) were randomized to ...